Sara Stewart, BS, and Alina Syros, MPH are first-year medical students at the University of Miami Miller School of Medicine. Jose Perez, MD is a third-year orthopedic surgery resident at the University of Miami.
Medical students and residents experience rigorous requirements in the journey to becoming physicians. Long hours, sleep deprivation, work overload, and emotional stress can contribute to students and residents neglecting their wellbeing to meet the requirements necessary for providing quality patient care. Because of the multitude of responsibilities medical students and residents encounter, wellness often becomes less of a priority. However, studies have shown diet and exercise are key components of wellness and critical factors in maintaining both the physical and cognitive function required to excel in high-demand professions [1]. As such, the sacrifices students and residents in medicine often make may hinder their ability to think clearly and provide adequate care for patients.
Numerous studies have sought to analyze and address wellness among medical students. Kotter et al. conducted a prospective, longitudinal observational study to determine how medical student health changes over the first year and found that 93% of students rated their physical health as “good” at the beginning of the first year [2]. By the end of the first year, this percentage had decreased to 76%. These findings were supported by McKerrow et al. [3], who found the median overall health score (scale of 1-5) of all medical students was highest at the beginning of M1 (4.71) and lowest at the end of M1 (4.07), with scores in subsequent years never reaching pre-medical school levels. This trend appears to continue into a medical residency, with upwards of 50% of residents reporting burnout [4]. One potential source of burnout among medical residents is a lack of time to focus on physical wellness, which is compounded by high workload and irregular schedules. One isolated study within a residency program reported that no residents (n=110) exercised over 150 minutes per week during inpatient rotations, which could have effects on overall wellness [5]. In addition, lingering feelings of fatigue and unaddressed burnout from medical school have been found to be a risk factor for experiencing burnout in residency [6].
These studies demonstrate that medical student and resident wellness is a significant issue facing medical trainees. One way to address this problem is by focusing on maintaining a healthy diet and exercising regularly [7]. Existing literature shows us that medical trainees and professionals who incorporate healthy eating and exercise into their daily lives report experiencing less burnout and higher quality of life, whereas a poor diet and a lack of regular physical activity have negative impacts on physical and mental health [8-10]. This article focuses on sharing healthy diets and exercises targeted towards health care professionals and medical students in an effort to improve wellbeing. In doing so, medical providers can be better equipped to meet the high demands required of physicians.
Diet and Nutrition
Maintaining a balanced diet and optimal nutritional habits offers numerous health benefits. Eating a healthy diet including vegetables, fruits, whole grains, and lean protein may prevent adverse physical health outcomes, including cardiovascular disease, type 2 diabetes, and stroke [11-13]. Beyond physical health, proper nutrition can also have positive effects on emotional and mental wellbeing. A systematic review conducted by Lai et al. aimed to discern the connection between dietary patterns and depression in adults [14]. Through a meta-analysis of studies examining a “healthy diet” (fish, whole grain, fruit, and vegetable consumption), the authors found that adults following a “healthy diet” had lower odds of depression than those with poor diets. Further, Conner et al. linked eating fruits and vegetables to increased vitality, flourishing, and motivation [15]. Their clinical intervention assigned young adults to either a diet-as-usual condition or a “fruit and vegetable” intervention, where fruits and vegetables were provided and encouraged for participants. Only participants in the intervention group demonstrated improved psychological well-being at the end of the study. These studies provide support for the role of balanced nutrition in improving mental and emotional health.
In order to ensure medical students and residents have sufficient education regarding nutrition, various medical schools have cultivated nutritional counseling and culinary medicine courses for their students [16 17]. The Perelman School of Medicine and Feinberg School of Medicine have both implemented elective courses where students learn culinary literacy, cooking skills, and nutritional counseling. In response to their elective course, medical students from Perelman felt more confident regarding their knowledge of nutrition and ability to discuss nutrition with patients (p<0.001) [16]. Students also noted they were inclined to introduce healthier eating habits into their daily routine. Similar results were found from Feinberg’s culinary medicine elective, where students reported a significant improvement in their confidence regarding their cooking abilities (p<0.010) and meal preparation skills (p<0.040) [17]. Students also demonstrated increased fruit and vegetable intake after the completion of the course (p=0.040). These data suggest that nutritional-based educational electives have the potential to instill in medical students habits of healthy eating that may persist throughout residency and their future careers.
Exercise
In addition to nutrition, physical activity has positive benefits on both physical and mental health. For example, physical activity is a protective factor against many chronic diseases such as cardiovascular disease, type 2 diabetes, and osteoporosis [18 19]. Beyond physical health, exercise has also been shown to improve mental health. LeBouthillier et al. conducted a randomized control trial to determine the effect of exercise on anxiety and found that both aerobic exercise and resistance training were effective at decreasing symptoms of anxiety [20]. The resounding evidence regarding the link between exercise and physical/mental wellbeing underscores the central role of physical activity in maintaining a medical trainee’s wellness.
Barriers to regular exercise routines are currently being addressed at both the medical student and resident physician level. Bitonte and Desanto proposed that exercise should be a mandatory curriculum requirement for able-bodied medical students as a preventive measure for mental illness and burnout [21]. They state that because medical students suffer from higher rates of mental illness than the general population, mandatory exercise should be implemented to be maximally effective in preventing mental illness and burnout while enforcing the importance of activity. While this may not be a feasible solution for all medical schools, exercise as an elective curricular component could be explored as an adjunctive modality to improving student wellness.
Similarly to medical students, resident physicians attribute the lack of dedicated time as the main barrier to exercise [22 23]. In response, the Mayo Clinic established an incentivized, team-based exercise program for residents [24]. Participants of the program demonstrated higher physical activity compared to non-participants (p<0.001). Participating residents also rated their quality of life (Scale: 1-100) significantly higher than non-participants (75 versus 68, respectively; p<0.001). Creating incentivized exercise plans with dedicated time for physical activity may encourage medical trainees to become more active and help improve their quality of life.
Conclusion
Medical students and residents face stress and burnout from a variety of factors, including long work hours, sleep deprivation, and social isolation, at the expense of physical and mental wellbeing. Proper nutrition and regular physical activity are two components of a healthy lifestyle that have the potential to substantially improve medical student and resident wellness. Establishing healthy habits and practices during one’s formative years in medical training is essential in ensuring a successful, lifelong career as a healthcare provider.
References
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